Crocs, scrubs and long hours – the telltale signs of a working nurse – are a far cry from the spike heels, short white dresses and party attitude of the nursing costumes that crop up every Halloween. For today’s nursing students, it’s hard to believe that nurses actually wore these white outfits – though notably less skimpy – less than three decades ago.

Attire reflects only one of the many changes in the profession that has influenced the way nurses approach their jobs every day. However, nurses have adapted to their continuously evolving profession, still striving to provide the most effective care for their patients.

Carol Amann, a Gannon University nursing instructor, cited dependencies on outpatient care and technology as the two most notable changes in nursing during the last 30 years. “There’s been a thousand ways it’s changed – especially how patients don’t stay in the hospital as long as they used to, and the way we used to do things that we wouldn’t even think about doing now because of technological advances,” she said.

Amann said that she thinks the transition from hospitalized care to outpatient care puts a heavier burden on today’s nurses.

Kim Inscoe, a senior nursing student and nurse’s aide, said that the shorter amount of time patients spend in the hospital, compared to the past, requires nurses to complete complex tasks more quickly.

Obstacles like language barriers or mental disabilities can slow down this process, Inscoe said, and some patients simply don’t tell the truth because they don’t realize which details can impact their diagnosis and treatment.

Inscoe said that nurses must have excellent communication skills, and even some investigative skills, to effectively assess a patient’s situation.

“Some people will just throw everything out there, but other people, you really have to dig, which can be frustrating,” she said. “Some people you really have to win over – and you need to do it in a short amount of time. It’s almost like speed dating sometimes.”

Such a quick turnaround can cause patients to come back if they don’t take care of themselves properly after being discharged, Amann said, which has increased home health nursing exponentially.

“Sometimes you sit straight up at night, making sure you remembered to do what you needed to do, because the day is so scrambled and hurried,” she said. “Thirty years ago in nursing, I had more time to get to know the person.”

Nurses use teamwork and technology to help adjust to these changes. Amann said that nurses need to depend on each other in order to effectively take care of their patients. “You need to trust your coworkers to support and back you up,” she said.

In addition to this collaboration, technology allows nurses to accomplish tasks more accurately and efficiently. For example, Inscoe said the computers on wheels that nurses take to patients’ rooms are indispensible. Inscoe said that computers improve communication and make it easier and faster for nurses to get results.

“The wheeled computers also have a drawer that has all of the patient’s medications; I can’t imagine trying to carry all of that around, and a chart,” she said. “I can’t imagine living without that – I don’t know how they did without it before. That flabbergasts me.”

Gannon 2008 alumna Allie Willis, a registered nurse with a bachelor’s degree in nursing, said that nurses have to make sure patients have the resources they need, including home health care and follow-up visits. Hospital cell phones can aid with this process, Willis and Inscoe said.

Willis said that many nurses carry cell phones on the hospital floor and allow discharged patients to call them if they have questions, which improves patient outcomes. “I’ve even had some people call afterward just to say, ‘Thank you for everything you’ve done,” Willis added.

Though not the primary purpose of such technology, this simple gesture makes all the difference – getting a thank you from a patient who a nurse has helped is “one of the best things,” according to Amann.

Another technological asset is a scanner that identifies patients by an assigned patient barcode, Inscoe said, which prevents mix-ups with patients and medication dosages. “There will still always be the human element of being able to make a mistake, but I think this helps a lot,” she said.

In fact, increased healthcare safety is another change that Amann noted. She said many safety techniques, like patient barcodes, are a result of the National Patient Safety Goals, released yearly by the Joint Commission on Healthcare Accreditation. Amann said that these goals have been “a huge benefit to everybody,” and that patient safety has taken the forefront of public healthcare.

“I think it’s made healthcare a safer place than it used to be,” she said.

Even simpler precautions, such as using disposable medical instruments, have increased patient safety, Amann said. “Infection control has taken a huge step forward; the very basic way we handle diseases has changed,” she said.

Another change that patients definitely notice – especially older patients – is the change in nursing attire. Amann said that since she first started nursing in 1979, dress requirements have changed drastically.

“It was a white dress, white stockings, white shoes, white hat, and your pin; never any nail polish or jewelry, and hair was always pulled up,” she said. Amann said 30 years ago, nurses were checked for this specific attire when they came into work.

“When I bought a pant suit for work, it was almost scandalous – but it was still white,” Amann said. “Then we moved into scrubs.”

For Inscoe, scrubs are all she has ever known in nursing. She said that she wouldn’t ever want to wear white as a nurse, because it’s such a dirty job. Because nursing is also physical, Inscoe said that she thinks the skirts were impractical, too.

“I think nurses wearing white is ridiculous – I get urine and vomit and blood on me all the time at work,” Inscoe said. “I don’t know how they did that. I think that the invention of scrubs is better than sliced bread.”

Amann said that differently colored scrubs, however, can cause patient confusion. Especially for elderly patients, who are used to seeing nurses in white, it can be difficult to differentiate between nurses and other hospital workers.

Amann said that although nurses don’t necessarily need to wear white, she feels that all hospitals should have different colored scrubs assigned to different positions, and some do. For example, UPMC Hamot nurses wear burgundy, Amann said.

Willis also said that scrubs can cause patients to confuse nurses with other hospital staff, and sometimes such confusion reflects gender stereotyping in the profession.

“Today, you walk into a hospital and you see men in nursing uniforms, which the patients think are doctors most of the time,” she said.

Another change in appearance is that it’s not unusual to see nurses with tattoos or unconventional hairstyles, Willis said, which also would not have been allowed 30 years ago.

Willis said that many elderly patients are not used to having men as nurses – another change in the profession – but that she hasn’t heard patients make any negative comments about male nurses.

“They think of men as authority figures, even though they’re wearing the same nursing uniforms as the women,” she said. “It’s weird, too, because it seems like there’s a different level of respect for the men even after the patients figure out that they aren’t doctors; they seem more likely to comply with instructions.”

Amann said that Willis’ observation about gender stereotyping is definitely accurate, and that it’s important for hospital staff to accurately convey their position to patients.

She said that diversity in nursing has increased somewhat, but “we still have a long way to go.” Nurses are still predominantly white females, she said, despite recruitment efforts targeted at males and minorities.

Tyler Babcock, a senior nursing student and emergency care assistant, said that Erie’s hospitals don’t have much diversity in terms of its nursing population, but he suspects that larger cities may have more. “Even if you look at Gannon’s program, there are only a handful of guys,” he said.

Inscoe said that she thinks males and minorities should definitely consider the nursing profession, as long as they’re cut out for the job. “I think that anybody, if they’re smart enough and driven enough, should be able to be a nurse,” she said. “You really have to have a certain personality to be a nurse – not just anybody can do it.”

This specific personality and skill set required to make a successful nurse must include the ability to establish rapport with patients, Willis said. Nursing has begun to emphasize a more holistic approach to patient care, she said, which is relationship-based and requires the nurse to assess the patient as a whole.

“You want to make the patient feel comfortable in an uncomfortable setting, basically, and relate to them and talk to them, addressing everything holistically – not just medically – and make sure that they’re safe when they leave,” she said.

Willis said that as a result of more holistic care, patient satisfaction levels have increased. She said that patients are often anxious in the hospital setting, and having a nurse to talk to like a “friend” helps them to feel more at home.

“I like to figure out what the patient is most afraid of, so that I can educate them, give them written information and discuss their feelings about everything that is going on,” she said. “They can sleep at night without worrying what’s going to happen the next day, because they feel comfortable asking questions.

“For example, if somebody is getting chemotherapy for the first time, I’ll ask them if they’re afraid and how they feel about it, and discuss how we can prevent their fears from happening and the safety measures we take to ensure their comfort throughout the process.”

Willis said that while nurses obviously provide medical care for patients, they don’t just stop there; they strive to make sure that patients are comfortable and understand what’s happening, too.

Amann said that nursing began to emphasize holistic care about 10 years ago, and that right now, there’s specifically a push for homeopathic care.

A type of holistic care, homeopathic care calls on a variety of individuals to care for a patient, including examples like spiritual approaches or music therapy, she said. “What we’re finding is that patients are responding very well to when we look at the whole versus the pieces,” Amann said, “but holistic care still has a long way to go.”

Babcock said that the holistic approach to nursing expanded in Erie, specifically, because of the osteopathic medicine movement, influenced locally by the Lake Erie College of Osteopathic Medicine, commonly known as LECOM.

He said that Erie employs many osteopathic doctors because of LECOM’s proximity. “Osteopathic medicine focuses on the holistic experience – the whole body instead of just certain systems,” he said. “I think nursing kind of adopted that whole movement.”

The movement toward holistic care – along with changes in technology, length of hospitalization, safety and education requirements, attire and diversity – demonstrates the ever-changing and developing nature of nursing. In fact, Amann said that the nursing profession changes every day. However, some of the biggest challenges and rewards of the nursing profession seemed to have remained constant over time.

Inscoe said that almost no patients are exactly textbook cases, and sometimes a patient’s health can hinge on a small detail.

“You could easily kill somebody as a nurse – it’s scary, but I’m confident because I have solid training and education,” she said. “And, I have a conscience, so every person I take care of means something to me – even the people on comfort care, who you know are going to die…that’s still a life that you’re taking care of until they die.”

Willis said that the most challenging aspect of nursing, for her, is having patients who never recover.

“The worst part is whenever you have patients who you can’t make better, and you get to know their families and personalities, and you have to watch them gradually decline while their family is forced to make medical decisions,” she said. “It’s hard to leave things like that at work, because you think about it, no matter what.”

Babcock said that nurses in any field will most likely have to deal with death at some point, and in his opinion, that’s the most difficult part of nursing.

“A majority of death in the emergency room in unexpected or accidental, so it’s kind of a different circumstance,” he said. “And, Erie doesn’t have a children’s hospital, so if a kid dies, we’re probably the ones who will see that happen, and that’s really hard.”

However, Willis said that being vulnerable to these emotions isn’t a bad thing, and that such experiences can help nurses learn about themselves, too. “Everybody’s afraid to feel anything negative, but whenever you put yourself out there and experience it, you know you’re helping someone else, and that’s enough,” she said.

Willis said that the best part of the nursing profession is getting to know many different types of people, realizing why they act the way that they do, and empathizing with their situation.

“When you’re running around doing everything you can for someone all day, and they stop to thank you or say you’ve done a good job, it’s the best reward,” she said.

Babcock also called the profession rewarding, and said that it’s an enjoyable job that makes a difference every day. “You know that you’re actually touching the life of at least one person every day when you go to work,” he said.

Willis said that she enjoys being a nurse, as well, and that she finds meaning in her profession.

“It’s beautiful and amazing all at the same time that we are able to make interventions that can allow people to go home and live with their families,” she said.

These interventions, along with medical advice, thorough care and a friendly face each day, create the moments that nurses share with their patients – whether the patient is actually able to go home with family members, or not.

When patients can no longer benefit from medical care, and do not have loved ones at their bedside, it is often a nurse who will provide comfort in his or her dying moments, amidst a hectic workday.

These daily, meaningful acts for an array of patients distinguish the nursing profession, and are what the nurses take home with them each day.

“The best thing is, when you go home and you know that you made a difference in someone’s life,” Amann said. “Whether big or small.”